Colleen Adult Family Care Home

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

Legal business name

COLLEEN ADULT FAMILY CARE HOME

Practice address

5615 Royal Hills St
Winter Haven, FL 33881-7703

Phone

(863) 307-1298

NPI assigned

Feb 17, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Colleen Marshall

Title

Owner

Phone

(863) 307-1298

Specialties & licenses 2

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1487289600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1551830400000",
    "number": "1538608930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5615 ROYAL HILLS ST",
            "city": "WINTER HAVEN",
            "state": "FL",
            "postal_code": "338817703",
            "telephone_number": "863-307-1298"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5615 ROYAL HILLS ST",
            "city": "WINTER HAVEN",
            "state": "FL",
            "postal_code": "338817703",
            "telephone_number": "863-307-1298"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLLEEN ADULT FAMILY CARE HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-17",
        "last_updated": "2019-03-06",
        "status": "A",
        "authorized_official_last_name": "MARSHALL",
        "authorized_official_first_name": "COLLEEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "863-307-1298"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "FL",
            "license": "6906156",
            "primary": false
        },
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "143074200",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alexandra Nora Cohen, MD
• Lenny Estela Cole, P.T.
• Emily Ruth Coleman
• Rhonda Coleman
• Trevon Lamar Coleman
• David Collins Jr., MD
• Angela Maria Colon Santiago, M.D
• Solimar Colon-Ortiz, LMHC
• Jonathan Colucci
• Caroline Grace Combs, PA-C

• Adult Care Home Facility in Winter Haven, FL
• Providers in Winter Haven, FL by specialty
• Adult Care Home Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.